"Watch out for the absolutization of science in medicine". Catrien Schimmelpenninck asks (in a personal capacity), striking questions about the starting point 'Appropriate care'. "When applied to control costs, this can lead us to lose context and common sense".
Catrien Schimmelpenninck is member of the Council for Public Health and Society in the Netherlands (de Raad voor Volksgezondheid en Samenleving). In this article in Medisch Contact, Schimmelpenninck sheds light on the dangers of the aforementionned approach.
It is an enlightening article with a striking analysis of trends that, also from an ethical point of view, are often at odds with what is best for the (individual) patient. It also conflicts with the principle of Deciding Together; taking stock of the pros and cons of a treatments' risks being taken from the patient when it comes to his/her quality of life.
We translated some parts of the article for your convenience.
"The first danger is that insufficient account is taken of the fact that non-proven effective is not the same as proven non-effective. For some forms of care it is impossible to provide a high level of evidence because it concerns complex care or a complex disorder, the research would take too long or it is unethical."
"The second danger of this narrowed application of appropriate care is that it leads to further absolutization of science. Of course, the scientific perspective in medicine is essential and the best we have, but it is by definition a simplification of reality. After all, not everything of value is measurable and not everything that is measurable is of value. Science is based on all kinds of choices, assumptions and interests. Nor is the assessment of science for package management exempt from choices, assumptions and influence. That is why involving other perspectives, including those from practice, is essential."
"The third danger is that the context is lost. Because reimbursements are increasingly linked to scientific evidence and guidelines are used as reimbursement criteria, rigid situations arise in which it is impossible to deviate from those guidelines."
She concludes "It is not for nothing that evidence-based medicine originally consists of an equal interplay between scientific insights, the experience and insights of the practitioner and the characteristics and preferences of the patient. However, these last two aspects are increasingly being removed from the consulting room and remotely generalized into rules, destroying the core of it. This standardization and uniformization are a disaster for patients, doctors and person-centred care."